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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM(Page i of e) Type of Action ❑Installation Test 0 Repair Test 0 Six Month Test p 36 Month Test I. FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181235 5/14/2019 Business Name(Same as Facility Name or DBA-Doing Business As) Arco 5450 Business Site Address City ZIP Code 1617 W. Fremont Stockton 195203 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the ICC Certification) Phone# David Rouse (925) 551-7555 Contractor 1 Tank Tester License# ICC Certification# ICC Certification Expiration Date 220793 8292530 6/25/2020 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID:(By tank number,stored product,etc) A T-1 Unleaded B T-2 Unleaded C T-3 Premium D Tank Containment Tightness Test Result p Pass ❑Fail ❑NA p Pass ❑Fail ❑NA p Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Product Piping Containment Tightness Test Result p Pass ❑Fail ❑NA [l Pass ❑Fa-1 ❑NA El Pass ❑Fail ❑NA ❑Pass ❑Fail [INA Communication Test Result El Pass ❑Fail ❑NA IS Pass ❑Fail ❑NA E7 Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Remote Fill Piping Containment Tightness Test Result ❑Pass ❑Fail p NA ❑Pass ❑Fail Cp NA ❑Pass ❑Fail M NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail p NA ❑Pass ❑Fail M NA ❑Pass ❑Fail p NA ❑Pass ❑Fail ❑NA Vent Piping Containment Tightness Test Result ❑Pass ❑Fail p NA ❑Pass ❑Fail E7 NA ❑Pass ❑Fail El NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail p NA ❑Pass ❑Fail 17 NA ❑Pass ❑Fail p NA ❑Pass ❑Fail ❑NA Vapor Recovery Piping Containment Tightness Test Result ❑Pass ❑Fail ©NA ❑Pass ❑Fail p NA ❑Pass ❑Fail p NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail [DNA ❑Pass ❑Fail ©NA ❑Pass ❑Fail M NA ❑Pass ❑Fail ❑NA Turbine t Product Piping Sump Tightness Test Result p Pass ❑Fail ❑NA El Pass ❑Fail ❑NA p Pass ❑Fal ❑NA ❑Pass ❑Fail ❑NA Fill Riser Sump Tightness Test Result p Pass ❑Fail ❑NA EI Pass ❑Fail ❑NA El Pass ❑Fail ❑NA ❑Pass ❑Fa,l ❑NA VENT l TRANSITION SUMP ID: a b C d Tightness Test Result ❑Pass ❑Fail O NA ❑Pass ❑Fail p NA ❑Pass ❑Fail I]NA ❑Pass ❑Fail ❑NA UDC ID: 1 112 2 314 3 516 4 718 Tightness Test Result El Pass ❑Fail ❑NA p Pass ❑Fail ❑NA E7 Pass ❑Fail ❑NA ©Pass ❑Fail ❑NA UDC ID: 5 6 7 8 Tightness Test Result ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA E7 Pass ❑Fall ❑NA UDC In: 9 10 11 12 Tightness Test Result ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA All items marked"Fail"or"NA"must be explained in their respective"COMMENTS"section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested in ordance with California Code of Regulations,Title 23,Division 3,Chapter 16,Section 2637 and all the Inf atlon c ine re, is accurate. UST Service Technician Signature CERS=Ca6foria Environmental Reporting System,ID=Identificabor.UST=Underground Storage Tank ICC=International Code Council,NA=Not Applicable,UDC=Under-